Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2024; 16(11): 3471-3483
Published online Nov 27, 2024. doi: 10.4240/wjgs.v16.i11.3471
How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience
Dania Nachira, Giuseppe Calabrese, Alessia Senatore, Valerio Pontecorvi, Khrystyna Kuzmych, Claudia Belletatti, Ivo Boskoski, Elisa Meacci, Alberto Biondi, Federico Raveglia, Vincenzo Bove, Maria Teresa Congedo, Maria Letizia Vita, Gloria Santoro, Leonardo Petracca Ciavarella, Filippo Lococo, Giovanni Punzo, Angelo Trivisonno, Francesco Petrella, Federico Barbaro, Cristiano Spada, Domenico D'Ugo, Ugo Cioffi, Stefano Margaritora
Dania Nachira, Giuseppe Calabrese, Alessia Senatore, Khrystyna Kuzmych, Claudia Belletatti, Elisa Meacci, Maria Teresa Congedo, Maria Letizia Vita, Leonardo Petracca Ciavarella, Filippo Lococo, Stefano Margaritora, Department of General Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Valerio Pontecorvi, Vincenzo Bove, Federico Barbaro, Cristiano Spada, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Ivo Boskoski, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Rome 00168, Italy
Alberto Biondi, General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome 00168, Italy
Federico Raveglia, Francesco Petrella, Department of Thoracic Surgery, IRCCS-San Gerardo dei Tintori, Monza 20900, Lombardy, Italy
Gloria Santoro, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome 00168, Italy
Giovanni Punzo, Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Lazio, Italy
Angelo Trivisonno, Department of Plastic Surgery, Assunzione di Maria Santissima Clinic, Rome 00135, Italy
Domenico D'Ugo, Department of Surgery, “Agostino Gemelli” University Hospital, Catholic University of Rome, Rome 00168, Italy
Ugo Cioffi, Department of Surgery, University of Milan, Milan 20122, Italy
Co-corresponding authors: Dania Nachira and Ugo Cioffi.
Author contributions: Nachira D, Calabrese G, Senatore A, Pontecorvi V, Belletatti C, Boskoski I, Biondi A, and Santoro G participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Nachira D wrote the manuscript; Nachira D, Boskoski I, Pontecorvi V, and Margaritora S accessed and verified the study data; Kuzmych K edited the English language; Meacci E, Raveglia F, Bove V, Congedo MT, Vita ML, Petracca Ciavarella L, Lococo F, Punzo G, Trivisonno A, Petrella F, Barbaro F, Spada C, D’Ugo D, and Cioffi U were involved in the interpretation of data and verified the study data; All authors critically reviewed and provided final approval of the manuscript, and were responsible for the decision to submit the manuscript for publication. Nachira D and Cioffi U assumed primary responsibility for the communication with the journal during the manuscript submission, peer-review, and publication process, sharing co-corresponding authorship.
Institutional review board statement: This study was evaluated by the Institutional Review Board (IRB) of Catholic University of Sacred Hearth and, as this was a retrospective review for service evaluation (within an audit approved by our Surgical Department). There was no modification in patient care (no prospective randomized study), and we did not need the final ethical approval of our IRB. In this study, the clinical data of 12 patients involved in a prospective trial [Endoscopic injection of Autologous Emulsified stromal vascular fraction (tSVFem) for the treatment of esophageal fistula] were also included and retrospectively reviewed along with the data of the other patients undergone standard treatments. This prospective trial was approved by the Ethical Committee (Università Cattolica del Sacro Cuore, Prot. ID 3127).
Informed consent statement: All study participants provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: Boskoski I is consultant for Apollo Endosurgery, Boston Scientific, Cook Medical, Nitinotes, Erbe Elektromedizin, Pentax Medical, Fractyl Health, and Lecturer for Microteach. All the other authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available. The data presented in this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dania Nachira, Doctor, Assistant Professor, Department of General Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Vito 8, Rome 00135, Italy. dania.nachira@policlinicogemelli.it
Received: June 28, 2024
Revised: September 9, 2024
Accepted: September 25, 2024
Published online: November 27, 2024
Processing time: 123 Days and 20.3 Hours
Abstract
BACKGROUND

Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition. The optimal management strategy is still unclear.

AIM

To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.

METHODS

A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023. Clinical outcomes were analyzed, and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus, when feasible.

RESULTS

Among the whole series of 60 patients, an urgent surgery was required in 8 cases due to a septic state. Fifty-six patients were managed by endoscopic or hybrid treatments, obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus. The mean time to resolution was 54.95 ± 52.64 days, with a median of 35.5 days. No severe complications were recorded. Ten patients out of 56 (17.9%) developed pneumonia that was treated by specific antibiotic therapy, and in 6 cases (10.7%) an atrial fibrillation was recorded. Seven patients (12.5%) developed a stricture within 12 months, requiring one or two endoscopic pneumatic dilations to solve the problem. Mortality was 1.7%.

CONCLUSION

A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

Keywords: Esophageal perforations; Postoperative leak; Endoscopic vacuum-assisted closure therapy; Metal stent; Endoscopic suture; Lateral esophagostomy; Autologous emulsified stromal vascular fraction

Core Tip: This is a retrospective single-center observational study to evaluate our multidisciplinary management of esophageal perforations and anastomotic leaks based on the preservation of the native or reconstructed esophagus when feasible. In our experience, the choice of the most appropriate treatment led to the resolution of the esophageal fistula with low morbidity and mortality and a reasonable mean resolution time. Long-term complications, as strictures, were also low and in line with the literature.